If you could live to be 100, would you want to?
Thanks to advances in medicine, public health, lifestyle, nutrition, and other factors, the average U.S. life expectancy has increased dramatically over the past century. In 1900, most people lived until about age 47. Today, it’s 78.6. The “oldest-old”—those 85 and older—are the fastest growing age group. By 2050, when the last of the baby boomers hits this milestone, some 19 million people will be over 85.
More people are also reaching the century mark than ever before. The number of Americans who live to be 100 and over increased 43.6 percent, from 50,281 in 2000 to 86,248 in 2017. The number of centenarians will balloon to 600,000 by 2060, according to the U.S. Census Bureau. Yet increased longevity is further straining an already stressed system, from health care to finances to housing.
Living to 100 is nice, but only under the right conditions, according to longevity researcher S. Jay Olshansky, professor of epidemiology and biostatistics at the University of Illinois, Chicago. “Life extension without health extension would be harmful,” he said. He suggested that aging researchers shift gears from trying to just live longer to trying to live healthier, because “how you live has a very powerful influence on health span.” This “compression of morbidity” will mean fewer years with serious disease, and it occurs closer to the end of life.
Unless those additional years of life are healthy, it will be a disaster, Olshansky explained. We have been able to extend lifespan through advances in treating conditions like heart disease and cancer. However, that could lead to more people developing Alzheimer’s disease or other serious chronic conditions. Modern medicine has been going down this path of extending life without considering the broader consequences, he explained in a recent JAMA article.
As more people live longer with chronic conditions, the demand on services and the need for care is increasing significantly, said Robyn Stone, senior vice president for research at LeadingAge. Stone is concerned that economic, workplace, and long-term care policies are woefully unprepared to support extended longevity. “Many people have not saved enough to live into their 90s,” she said. “That impacts quality of life and economic security.”
Unfunded pensions and health care liabilities, already in the trillions of dollars, are expected to soar as millions baby boomers retire over the next decade, according to a report from Longevity International. It could lead to rising poverty among the elderly, higher taxes, inflation, and even political instability.
In 2014, 6.1 percent of men and 11.2 percent of women over 85 were in a nursing home, according to Statista. But the vast majority of older adults were cared for at home by family and other loved ones. The Family Caregiver Alliance reports that about 30 percent of the older population (1.5 million people) with long term care needs in the community have substantial (three or more) limitations in activities of daily living. Of these, 25 percent are 85 and older. However, the pool of available caregivers is dwindling. AARP projects that by 2030, the number of family caregivers for those aged 80 and older—will shrink almost 50 percent.
“Who will care for this older, frailer, sicker population,” Stone asked. How do you provide services for the very old with finite resources?
She said it’s vital to look at increased longevity through a socioeconomic lens, not just as a medical or biological achievement. “Are we prepared? Do we have the policies and systems in place to support this?”
Longevity researchers should consider what increased lifespan would mean for those on Social Security and pensions, as well as what a burgeoning population of “oldest old” would do to Medicare, Medicaid and the U.S. health system. “We already don’t have enough primary care providers, we don’t have affordable, appropriate housing, enough community-based services or caregiver support,” Stone said.
According to Olshansky, living to be 100 requires both financial and physical planning. “There’s going to be considerable inequity in health and survival in older age because of how people have prepared. Those who have prepared well will probably enjoy their older years.”
He also pointed to the need to address racial and ethnic health disparities. Factors like education, income, and access to health care are very powerful forces, but there are subgroups of the population, regardless of education or wealth, that have risk factors like obesity. “There’s no question that the most important thing you can be doing at any age is physical activity. That influences both body and mind and the benefits are immediate,” he said. It doesn’t matter whether it’s walking or swimming or gardening. Just get moving, Olshansky advised.
It may not be long before we can live to be 100 with delayed frailty and disability. We need to prepare for this eventuality now on both the personal and policy levels, said Stone. It’s especially important to ensure future economic security. “Extending longevity without extending savings is scary.”